What are the clinical and educational risk factors for poor academic outcomes in children with Autistic Spectrum Disorder?

大约1%的英国学龄儿童患有自闭症谱系障碍(ASD)。患有自闭症的儿童通常在使用语言、参与日常社交活动以及对周围世界有广泛而灵活的兴趣方面存在长期的困难。自闭症通常在小学一年级被诊断出来。大多数被诊断为自闭症的儿童在整个学校生活中都会遇到困难，往往是在没有资格证书的情况下离开。这使他们在成年后处于显著的不利地位，并面临着更大的心理和身体健康问题的风险。英国儿童心理健康专家、教师和研究人员的一个重要目标是减少自闭症儿童在校期间的这些教育缺陷，确保他们在以后的生活中拥有更好的技能和机会。在英国，儿童和青少年心理健康专科服务(CAMHS)通常提供自闭症评估和治疗。CAMHS服务还治疗常见的儿童心理健康问题，包括焦虑、抑郁、行为和多动障碍。患有这些障碍的无自闭症儿童往往在学校很难实现他们的潜力。幸运的是，有许多有效的心理健康治疗，包括可以帮助非自闭症儿童重回正轨的药物。这些治疗增加了他们上学、不惹麻烦和通过考试的机会。患有自闭症的儿童也患有这些障碍，其发生率(在一些研究中高达70%)比正常发育儿童要高得多。自闭症合并其他精神健康障碍是一种更复杂的疾病，需要管理，并可能显著影响教育成绩。目前，几乎没有证据可以告诉临床医生如何最好地治疗与ASD相关的常见并存疾病。药物治疗主要是在非自闭症儿童身上开发的，在提高自闭症儿童的学习成绩方面可能不会有同样的效果。CAMHS越来越多地使用药物治疗(例如兴奋剂、抗抑郁药和抗精神病药物)来帮助管理患有自闭症儿童的常见共生疾病。目前，临床医生给ASD儿童开这些药物的原因尚不清楚是哪些疾病或其他症状导致的。此外，在患有自闭症的儿童中进行的实验试验很少，这些试验的设计足以衡量治疗的长期效果，因此它们对总出勤率、排斥率或期末考试成绩等长期教育结果的影响尚不清楚。有了强有力的保密和数据保护措施，电子健康记录(EHR)可以提供丰富的数据来调查当前知识的差距。它们可以用来确定哪些童年因素会导致自闭症的教育表现受损，以及如何通过治疗来改变这些因素。对于这项建议，我将通过临床记录交互搜索系统(CRIS)使用EHR，并将记录与国家学生数据库(NPD)联系起来。CRIS由伦敦国王学院开发，使研究人员能够从34,000多名CAMHS患者的匿名病例笔记中检索深入信息。NPD是由教育部管理的一个数据库，其中包含自2002年起在公立学校入学以来的所有儿童的学业记录。作为奖学金申请者，我将在伦敦国王学院的Hotopf教授和Hayes博士以及埃克塞特大学的Ford教授的监督下，研究额外的精神健康困难是否会影响学习成绩，以及可能减少这些困难的治疗是否可以改善学业成绩。

Approximately 1% of UK school age children have an Autistic Spectrum Disorder (ASD). Children with ASD typically have longstanding difficulties using language, engaging in every day social interactions and having a general, flexible interest in the world around them. ASD is commonly diagnosed in the first years of primary school. The majority of children who receive an ASD diagnosis will go on to have difficulties throughout their school life, often leaving with no qualifications. This puts them at a significant disadvantage as adults and at greater risk for a host of mental and physical health problems. An important objective for UK child mental health specialists, teachers and researchers is to reduce these educational failings for children with ASD whilst at school, to ensure they have better skills and opportunities in later life.In the UK, specialist Child and Adolescent Mental Health Services (CAMHS) commonly provide ASD assessments and offer treatment. CAMHS services also treat common childhood mental health conditions including anxiety, depression, conduct and hyperactivity disorders. Children without ASD who suffer these disorders often have considerable difficulties achieving their potential at school. Fortunately there are a number of effective mental health treatments including medications that can help non ASD children get back on track. These treatments increase their chances of attending school, not getting into trouble and passing exams.Children with ASD also suffer from these disorders and at much greater rates (up to 70% in some studies) than typically developing children. ASD combined with other mental health disorders presents as a much more complex condition to manage and may significantly impact educational performance. Currently there is little evidence available to inform clinicians on how best to treat the common co-occurring conditions associated with ASD. Pharmacological treatments, developed primarly in non ASD children, may not have the same effect in improving educational performance for ASD children. Pharmacological treatments (for example stimulants, anti-depressants and anti-psychotics) are being increasingly used by CAMHS to help manage common co-occurring disorders in children with ASD. At present, little is known which disorders or additional symptoms lead clinicians to prescribe these medications to children with ASD. Also, very few experimental trials are conducted in children with ASD that are adequately designed to measure the long term effect of treatment, therefore their influence on longer term educational outcomes like overall school attendance, exclusion rates or final exam results remains unclear. With robust confidentiality and data protection measures in place, electronic health records(EHRs) can provide rich data to investigate the gaps in current knowledge. They can be used to determine which childhood factors lead to impaired educational performance in ASD, and how they may be modified by treatment. For this proposal, I will use EHRs via the Clinical Record Interactive Search system(CRIS) and link the records with the National Pupil Database(NPD). CRIS was developed by King College London to allow researchers to retrieve in depth information from the anonymised case notes of over 34,000 CAMHS patients. The NPD is a database managed by the Department for Education and contains all children academic records since enrolment in state school from 2002. As the fellowship applicant, under the supervision of Professor Hotopf and Dr Hayes at Kings College London, and Professor Ford at the University of Exeter, I will study whether additional mental health difficulties impact on educational performance and whether treatments that may reduce these difficulties could improve academic outcomes.